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July 25, 2014 5:11 pm
In the days following the great Wall Street crash of 1929, popular newspapers in London were full of sensational stories. “Speculators were hurling themselves from windows,” JK Galbraith relates wryly in his little classic The Great Crash 1929; “pedestrians picked their way delicately between the bodies of fallen financiers.” Not for the first or last time, the press was making things up. “The suicide wave that followed the stock market crash,” Galbraith continues, “is part of the legend of 1929. In fact, there was none.”
What actually happened was more stealthy and far more deadly. Suicide rates rose quite sharply in the Depression years following 1929 across the US population as a whole, peaking in 1932 with 17.4 suicides per 100,000 of population for the US as a whole (up from 14 in 1929) and 21.3 in New York City (up from 17 in 1929). These increases may look rather small but they add up to several thousands of deaths.
Following the credit crunch of 2008, and especially over the past 18 months or so the deaths of a number of financiers drew media attention. Gabriel Magee, a 39-year-old vice-president at JPMorgan Chase, died after falling from the company’s 33-storey London headquarters. On January 26 this year the retired senior Deutsche Bank risk executive William Broeksmit was found hanging at his home in Chelsea. These cases are individually tragic but, again, they partially obscure a much larger tragedy.
I’ve been reading an interesting paper published in the British Medical Journal on September 17 last year whose objective was “to investigate the impact of the 2008 global economic crisis on international trends in suicide and to identify sex/age groups and countries most affected”. The methodology seems sound and the conclusions sobering. The authors “found a clear rise in suicide after the 2008 global economic crisis; there were about 4,900 excess suicides in the year 2009 alone compared with those expected based on previous trends (2000-07).” That figure is striking. However, the authors go on to remark that they may well be underestimating the global impact of the credit crunch on suicide rates, as they do not include such countries as Italy and Australia. And quite correctly they add that “the rise in the number of suicides is only a small part of the emotional distress caused by the economic downturn”.
Every suicide, as I know from my own family, is a mystery and a black hole, which drains emotional energy over generations. The toll of thousands of suicides is great. But they are only the most dramatic manifestation of emotional distress, even in normal times.
Mental health, for all the official pronouncements to the contrary, is still regarded as less important or serious than physical health. I suspect the main reason is invisibility. “There’s no art to find the mind’s construction in the face,” as Duncan, with proleptic irony, noted in Macbeth long ago. Terrible mental suffering may be less apparent, from the outside, than a broken toe.
In any case, the true scale of the neglect of mental health in Britain is laid bare in Thrive, a remarkable and passionately argued new book by economics professor Lord Richard Layard and the clinical psychologist David Clark, which my colleague Martin Wolf wrote about earlier this month. “While nearly everyone who is physically ill gets treatment,” write Layard and Clark, “two in three of those who are mentally ill do not.” This sounds shocking enough but it is made more indefensible by the fact that effective and relatively inexpensive treatments exist. These are various kinds of therapy, including cognitive behavioural therapy – the favourite of Layard and Clark – and, in some cases, drugs.
The cost of these treatments is modest and it is more than offset, Layard and Clark argue, by the savings in benefit payments and in the treatment of physical illnesses made worse by mental illness. Those are quite narrow and economistic arguments; we do not need to justify expenditure on physical illness, including the relief of terrible pain, merely on the grounds of savings to the economy.
For the past couple of years, a senior psychiatrist friend has been telling me that for all the talk of the ringfencing of the NHS budget in England, he has been forced to cut the mental health services he manages by as much as 20 per cent. More recently he told me about something more insidious – or you could even say sneaky. Changes to the benefit system, based on the unexceptionable principle that no one should be considered a priori incapable of working are, in practice, he suggests, militating against the mentally ill. People suffering from acute anxiety, panic attacks or agoraphobia are more likely to be deterred by deliberate bureaucratic hurdle-building. Making life more difficult for mentally distressed people, in tough economic times, strikes me as both cruel and stupid.
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